关键词: 非糜烂性反流病, 反流高敏感, 烧心, 高分辨率食管测压, pH监测, pH-阻抗监测

Abstract: Objective To investigate the symptom and esophageal function in patients with reflux hypersensitivity (RH) and non-erosive reflux disease(NERD). Methods In this study, 60 patients concurrently taking the examinations of upper gastrointestinal endoscope, high-resolution manometry and impedance (HRiM) and multi-channel intraluminal impedance and pH recording (MII/pH) between Nov. 2017 and Mar. 2019 were selected from Beijing Hospital of Traditional Chinese Medicine, Capital Medical University. The patients were separated into RH group and NRED group with 30 cases in each group, according to their symptoms and examinations, to compare the GerdQ Scale Score, esophageal manometry, and pH & impedance pH monitoring between the two groups. Results The scores of negative symptoms (upper abdominal pain, nausea) in RH group were significantly higher than that in NERD group (ie, the incidence of RH group was lower than NERD group), with statistically significant difference(P<0.05).There was no statistical significant difference in the score of GerdQ, positive symptoms(heartburn, reflux), and positive effects(sleep disorders, the usage of OTC drugs) between the two Groups(P>0.05). The residual pressure of lower esophageal sphincter(LES) in RH group was obviously lower than that in NERD group(P<0.05). There was no statistical significant difference in the length of LES, resting pressure of LES, resting pressure of upper esophageal sphincter(UES), average distal contractile integral(DCI), distal contraction delay, percentage of early contraction, percentage of rapid contraction, percentage of large peristalsis interruption, percentage of small peristalsis interruption between the two groups (average P>0.05).The total reflux duration, reflux times; upright position reflux duration, reflux times; supine position reflux duration, reflux times; long reflux times, the longest reflux duration, the proportion of total acid exposure and the proportion of standing, supine position acid exposure, De Meester score, and the acid reflux events of RH group were obviously lower than those in the NERD group(P<0.05). No statistical significant difference was observed between the two groups in the weak acid reflux and non-acid reflux events(P>0.05). Conclusion The symptoms of upper abdominal pain and nausea were obviously less than those in NERD group. The residual pressure of LES in RH group was obviously lower than that in the NERD group; the total reflux duration, reflux times, upright position reflux duration, reflux times, supine position reflux duration, reflux times; long reflux times, the longest reflux duration, the proportion of total acid exposure and the proportion of standing, supine position acid exposure, De Meester score, and the acid reflux events of RH group were obviously lower than those in the NERD group. For patients with typical heartburn symptoms but normal examined with endoscopy and biopsy, high-resolution esophageal manometry and pH & impedance pH monitoring are required to confirm the diagnosis so that the specific treatments are provided to relieve their clinical symptoms.

Key words: non-erosive reflux disease, reflux hypersensitivity, heartburn, high-resolution esophageal manometry, pH monitoring, impedance pH monitoring